The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transp...The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic 展开更多
To investigate the expression of vaginal Th1 and Th2 cytokines in rats with experimental vaginal candidiasis under different immune conditions, ICR murine vaginal candidiasis model was established and immno-suppressed...To investigate the expression of vaginal Th1 and Th2 cytokines in rats with experimental vaginal candidiasis under different immune conditions, ICR murine vaginal candidiasis model was established and immno-suppressed murine models of vaginal cadidiasis were established in estrogen-treated mice. Non-estrogen-treated mice were used as controls. The mRNA level of Th1 （IL-2）/Th2 （IL-4, IL-10, TGF-β1） cytokines in murine vaginal tissues was determined by RT-PCR. The cykotine in local tissues was increased to different extent under normal immune condition. IL-2 mRNA was increased during early stage of infection, while IL-10 was increased transiently during late stage of infection. TGF-β1 production was found to be increased persistently. At same time, the expression of IL-2 mRNA was suppressed in immno-suppressed group, and the level of IL-4, IL-10, and TGF-β1 were higher than the normal immunity group to different degree during infection. The high level of IL-2 mRNA during early stage of infection was associated with clearance of mucosal Candidia albicans （C. albicans）, and its expression suppressed leading to decreased clearance of mucosal C. albican in immuno-suppression. The over-expression of IL-4 and IL-10 could significantly enhance the susceptibility to C. albicans infection in mice.展开更多
Objective：To investigate the mechanism of action of emodin for suppressing acute allograft rejection in a rat model of liver transplantation.Methods：Brown Norway（BW） recipient rats of orthotopic liver transplantat...Objective：To investigate the mechanism of action of emodin for suppressing acute allograft rejection in a rat model of liver transplantation.Methods：Brown Norway（BW） recipient rats of orthotopic liver transplantation（OLT） were divided into three groups,Group A receiving isografting（with BW rats as donor）, Group B receiving allografting（with Lewis rats as donor）,Group C receiving allografting and emodin treatment （50 mg/kg daily）.They were sacrificed on day 7 of post-transplantation,and their hepatic histology,plasma cytokine levels,and T-cell subset expression were detected.Results：Compared with those in Group A,rats in Group B exhibited severe allograft rejection with a rejection activity index（RAI） of 7.67±0.98,extensive hepatocellular apoptosis with an apoptosis index（Al） of 35.83±2.32,and elevated plasma levels of interleukin-2 （IL-2）,interleukin-10（IL-10）,tumor necrosis factor-α（TNF-α）,CD4^＋ and CD4^＋/CD8^＋ ratio.However,recipients in Group C showed a decrease in histological grade of rejection and hepatocellular apoptosis,as well as a decrease in plasma levels of IL-2,TNF-α,CD4^＋ and CD4^＋/CD8^＋ ratio,but elevated levels of IL-10 as compared with the allograft group.Conclusion：Post-OLT acute rejection could be attenuated by emodin,its mechanism of action may be associated with protecting hepatocytes from apoptosis,polarizing the Th 1 paradigm to Th2,and inhibiting the proliferation of CD4^＋ T cell in plasma.展开更多
We described a 59-year-old male patient who underwent liver transplantation in 1989 for hepatocellular carcinoma （HCC） complicating hepatitis B virus （HBV） cirrhosis. In 2001 （12 years after liver transplantation...We described a 59-year-old male patient who underwent liver transplantation in 1989 for hepatocellular carcinoma （HCC） complicating hepatitis B virus （HBV） cirrhosis. In 2001 （12 years after liver transplantation）, he developed a lung metastasis of HCC without intrahepatic recurrence and the resection was done. In July 2003, he was symptom free without any recurrence. HCC metastasis can develop even after a very long time of liver transplantation. Many HCCs grow slowly, and the growth rate of recurrent tumors in patients receiving immunosuppressive therapy is significantly greater than that of those who do not receive immunosuppressive therapy.展开更多
文摘The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic
基金the Science Research Foundation of Health Department of Hubei Prov-ince (No. JXIB048)Janssen Research Foundation
文摘To investigate the expression of vaginal Th1 and Th2 cytokines in rats with experimental vaginal candidiasis under different immune conditions, ICR murine vaginal candidiasis model was established and immno-suppressed murine models of vaginal cadidiasis were established in estrogen-treated mice. Non-estrogen-treated mice were used as controls. The mRNA level of Th1 （IL-2）/Th2 （IL-4, IL-10, TGF-β1） cytokines in murine vaginal tissues was determined by RT-PCR. The cykotine in local tissues was increased to different extent under normal immune condition. IL-2 mRNA was increased during early stage of infection, while IL-10 was increased transiently during late stage of infection. TGF-β1 production was found to be increased persistently. At same time, the expression of IL-2 mRNA was suppressed in immno-suppressed group, and the level of IL-4, IL-10, and TGF-β1 were higher than the normal immunity group to different degree during infection. The high level of IL-2 mRNA during early stage of infection was associated with clearance of mucosal Candidia albicans （C. albicans）, and its expression suppressed leading to decreased clearance of mucosal C. albican in immuno-suppression. The over-expression of IL-4 and IL-10 could significantly enhance the susceptibility to C. albicans infection in mice.
基金Supported by the National Natural Science Foundation of China (No.30572395,No.30973815).
文摘Objective：To investigate the mechanism of action of emodin for suppressing acute allograft rejection in a rat model of liver transplantation.Methods：Brown Norway（BW） recipient rats of orthotopic liver transplantation（OLT） were divided into three groups,Group A receiving isografting（with BW rats as donor）, Group B receiving allografting（with Lewis rats as donor）,Group C receiving allografting and emodin treatment （50 mg/kg daily）.They were sacrificed on day 7 of post-transplantation,and their hepatic histology,plasma cytokine levels,and T-cell subset expression were detected.Results：Compared with those in Group A,rats in Group B exhibited severe allograft rejection with a rejection activity index（RAI） of 7.67±0.98,extensive hepatocellular apoptosis with an apoptosis index（Al） of 35.83±2.32,and elevated plasma levels of interleukin-2 （IL-2）,interleukin-10（IL-10）,tumor necrosis factor-α（TNF-α）,CD4^＋ and CD4^＋/CD8^＋ ratio.However,recipients in Group C showed a decrease in histological grade of rejection and hepatocellular apoptosis,as well as a decrease in plasma levels of IL-2,TNF-α,CD4^＋ and CD4^＋/CD8^＋ ratio,but elevated levels of IL-10 as compared with the allograft group.Conclusion：Post-OLT acute rejection could be attenuated by emodin,its mechanism of action may be associated with protecting hepatocytes from apoptosis,polarizing the Th 1 paradigm to Th2,and inhibiting the proliferation of CD4^＋ T cell in plasma.
文摘We described a 59-year-old male patient who underwent liver transplantation in 1989 for hepatocellular carcinoma （HCC） complicating hepatitis B virus （HBV） cirrhosis. In 2001 （12 years after liver transplantation）, he developed a lung metastasis of HCC without intrahepatic recurrence and the resection was done. In July 2003, he was symptom free without any recurrence. HCC metastasis can develop even after a very long time of liver transplantation. Many HCCs grow slowly, and the growth rate of recurrent tumors in patients receiving immunosuppressive therapy is significantly greater than that of those who do not receive immunosuppressive therapy.
